Petrides P E, Müller-Höcker J, Fredricks D N, Relman D A
Department of Medicine III, Munich University School of Medicine, Grosshadern, Germany.
Am J Gastroenterol. 1998 Sep;93(9):1579-82. doi: 10.1111/j.1572-0241.1998.00416.x.
A 58-yr-old man developed severe weight loss, arthralgias, and diarrhea. Endoscopic examination of the stomach and duodenum revealed thickened folds of duodenal mucosa. Biopsy of the gastric mucosa was negative, whereas duodenal biopsy revealed blunted epithelial villi and PAS-positive foamy macrophages within the lamina propria. Bacilli typical of those associated with Whipple's disease were found by electron microscopy. The diagnosis was confirmed by polymerase chain reaction (PCR) assay, which detected a portion of the 16S ribosomal RNA gene sequence corresponding to the Whipple bacillus (Tropheryma whippelii) in duodenum, stomach, and liver biopsies before therapy. T. whippelii DNA was eliminated from all tissues tested within 3 months of starting antibiotic treatment, but the histological improvement lagged behind the clinical and molecular evidence of improvement.
一名58岁男性出现严重体重减轻、关节痛和腹泻。对胃和十二指肠进行内镜检查发现十二指肠黏膜皱襞增厚。胃黏膜活检结果为阴性，而十二指肠活检显示上皮绒毛变钝，固有层内有PAS阳性的泡沫状巨噬细胞。通过电子显微镜发现了与惠普尔病相关的典型杆菌。聚合酶链反应（PCR）检测证实了诊断，该检测在治疗前的十二指肠、胃和肝脏活检中检测到了与惠普尔杆菌（ Tropheryma whippelii）相对应的16S核糖体RNA基因序列的一部分。开始抗生素治疗后3个月内，所有检测组织中的T. whippelii DNA均被清除，但组织学改善落后于临床和分子水平的改善证据。
